Yellow Fever Vaccines

(BAN, rINN)

💊 Chemical information

Vacunas de la fiebre amarilla.
ATC — J07BL01.

Pharmacopoeias.

Many pharmacopoeias, including Eur. and US, have monographs.

Ph. Eur. 6.2

(Yellow Fever Vaccine (Live); Vaccinum Febris Flavae Vivum). A freeze-dried preparation of the 17D strain of yellow fever virus grown in fertilised hen eggs. It is reconstituted immediately before use. It should be stored at 2° to 8° and be protected from light. The BP 2008 states that Yel(live) may be used on the label.

USP 31

(Yellow Fever Vaccine). A freeze-dried preparation of a selected attenuated strain of live yellow fever virus cultured in chick embryos. It is reconstituted, just prior to use, by the addition of sodium chloride containing no antimicrobial agent. It should be stored under nitrogen preferably below 0° but not above 5°.

💊 Adverse Effects and Precautions

Local and general reactions are not common after vaccination for yellow fever. Very rarely encephalitis has occurred, generally in infants under 9 months of age. Therefore, yellow fever vaccine is not usually given to infants under 9 months (but see Vaccine-associated Neurotropic Disease, below). There is as yet limited data on the safety of yellow fever vaccine in HIV-positive individuals. In the UK, it is recommended that specialist advice should be sought regarding the use of yellow fever vaccine in such individuals. WHO advises that the vaccine should be given to HIV-positive individuals who are asymptomatic if the risk of infection is high.

Pregnancy.

Although yellow fever vaccine has been given to women during pregnancy without producing adverse effects in the infants,1 fetal infection has been reported.2 US recommendations3 therefore advise that the safety of yellow fever vaccination during pregnancy has not been established and the vaccine should only be given to pregnant women if travel to an endemic area is unavoidable and if an increased risk of exposure exists. Infants born to these women should be monitored closely for evidence of congenital infection or other adverse effects.
1. Nasidi A, et al. Yellow fever vaccination and pregnancy: a fouryear prospective study. Trans R Soc Trop Med Hyg 1993; 87: 337–9
2. Tsai TF, et al. Congenital yellow fever virus infection after immunization in pregnancy. J Infect Dis 1993; 168: 1520–3
3. CDC. Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002. MMWR 2002; 51 (RR-17): 1–11. Also available at: http://www.cdc.gov/ mmwr/PDF/rr/rr5117.pdf (accessed 25/05/06)

Vaccine-associated neurotropic disease.

Yellow fever vaccine has been associated with rare reports of encephalitis, now termed vaccine-associated neurotropic disease (YEL-AND). WHO has stated1 that, since 1945, there have been at least 26 cases of proven or probable YEL-AND of which 16 occurred in infants aged less than 6 months. Of the 26 cases, 24 recovered without further complications and there were 2 fatalities.1 Vaccine virus recovered from one of the fatalities, a 3-year-old child, revealed that mutation had occurred in the envelope gene of the virus, but it is not known whether similar mutations occurred in the other cases. The other fatality occurred in an immunocompromised adult with HIV infection. As a precaution against possible encephalitis, infants less than 9 months of age are not generally immunised, although it may be advisable to immunise at 6 to 8 months of age during epidemics.
1. WHO. Yellow fever vaccine: WHO position paper. Wkly Epidem Rec 2003; 78: 349–59.

Vaccine-associated viscerotropic disease.

Yellow fever vaccine has been associated with rare reports of multiple organ failure, now termed yellow fever vaccine-associated viscerotropic disease (YEL-AVD). WHO has stated1 that, between 1996 and 2001, there were 7 recorded cases of YEL-AVD of which 2 occurred in Brazil,2 4 in the USA,3 and one in Australia.4 Six of these 7 cases were fatal. A further case, also leading to fatality, was reported to have occurred in Spain in 2004.5 It has been suggested that the most likely explanation is an idiosyncratic host susceptibility to the 17D vaccine strain rather than a reversion of the vaccine strain to a wild-type strain.5 There is also some evidence to suggest that the risk of YEL-AVD is greater in patients aged over 60 years.6
1. WHO. Yellow fever vaccine: WHO position paper. Wkly Epidem Rec 2003; 78: 349–59
2. Vasconcelos PFC, et al. Serious adverse events associated with yellow fever 17DD vaccine in Brazil: a report of two cases. Lancet 2001; 358: 91–7. Corrections. ibid.; 336. ibid.; 1018
3. Chan RC, et al. Hepatitis and death following vaccination with 17D-204 yellow fever vaccine. Lancet 2001; 358: 121–2
4. Martin M, et al. Fever and multisystem organ failure associated with 17D-204 yellow fever vaccination: a report of four cases. Lancet 2001; 358: 98–104
5. Agencia Española del Medicamentos y Productos Sanitarios. A death associated with yellow fever vaccination reported in Spain. Available at: http://www.eurosurveillance.org/ ew/2004/041104.asp (accessed 25/08/05
6. Khromava AY, et al. Yellow fever vaccine: an updated assessment of advanced age as a risk factor for serious adverse events. Va cc in e 2005; 23: 3265–63.

💊 Uses and Administration

Yellow fever vaccines are used for active immunisation against yellow fever. Immunity is usually established within about 10 days of administration and persists for many years. Only one dose is required for immunisation and is given by deep subcutaneous injection; the dose (0.5 mL) is the volume containing at least 1000 mouse LD 50 units. In the UK, immunisation against yellow fever is recommended for laboratory workers handling infected material, for persons travelling through or living in areas of infection, and for travellers entering countries which require an International Certificate of Vaccination. The immunity produced may last for life although officially an International Certificate of Vaccination against yellow fever is valid only for 10 years starting 10 days after the primary immunisation and only if the vaccine used has been approved by WHO and given at a designated centre. Vaccination under 9 months of age is not generally recommended (see Adverse Effects and Precautions, above).
1. Barrett ADT. Yellow fever vaccines. Biologicals 1997; 25: 17–25.
1. CDC. Yellow fever vaccine: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2002. MMWR 2002; 51 (RR-17): 1–11. Also available at: http://www.cdc.gov/ mmwr/PDF/rr/rr5117.pdf (accessed 25/05/06)

Immunisation schedules.

The 17D (Rockefeller) yellow fever vaccine is now the only yellow fever vaccine produced.1,2The quantity available in the world has been limited and its relatively short half-life does not permit the accumulation of large stocks. The demand for the vaccine is also somewhat irregular, being suddenly high during epidemics and low during inter-epidemic periods. In Africa and in South America two different strategies for yellow fever immunisation have been followed.1,2 Firstly, an emergency immunisation programme takes place once an outbreak has begun, in an attempt to limit the spread of infection by immunising all persons in the focus, regardless of their former immune status. One disadvantage is that immunity does not appear until 7 days after immunisation and deaths may be expected to occur in the interim period. Secondly, a routine mass immunisation programme for yellow fever is aimed at immunising in advance all populations considered to be at risk. Yellow fever vaccine is included in the WHO Expanded Programme on Immunization; there are obvious logistic advantages in giving it at the age of 9 months at the same time as measles vaccine. In rural areas of the endemic zone that are considered at high risk, the minimum age for routine immunisation may be lowered to 6 months (see Vaccine-associated Neurotropic Disease, above).
1. WHO. Prevention and control of yellow fever in Africa. Geneva: WHO, 1986
2. WHO. Yellow fever vaccine: WHO position paper. Wkly Epidem Rec 2003; 78: 349–60.

Immunisation for travellers.

A guide entitled International Travel and Health is published annually by WHO. Information is provided concerning the countries in Africa and South America where yellow fever is endemic and also countries requiring a traveller to hold a valid vaccination certificate. For some further details.

💊 Preparations

Ph. Eur.: Yellow Fever Vaccine (Live); USP 31: Yellow Fever Vaccine.

Proprietary Preparations

Arg.: Stamaril; Austral.: Stamaril; Belg.: Stamaril; Canad.: YF-Vax; Chile: Stamaril; Cz.: Stamaril; Denm.: Stamaril; Fin.: Arilvax†; Stamaril; Fr.: Stamaril; Ger.: Stamaril; Irl.: Arilvax†; Stamaril; Israel: Arilvax; Ital.: Stamaril; Malaysia: Stamaril†; Neth.: Arilvax; Stamaril; Norw.: Stamaril; NZ: Stamaril; Pol.: Stamaril; Port.: Stamaril; S.Afr.: Arilvax; Stamaril; Singapore: Arilvax†; Stamaril; Swed.: Arilvax†; Stamaril; Switz.: Arilvax†; Stamaril; Turk.: Stamaril; UK: Arilvax; Stamaril; USA: YF-Vax; Venez.: Stamaril†. UK: Ellimans; Goddards Embrocation; Phytex; Potters Gees Linctus; Sanderson’s Throat Specific; USA: Acetasol; Acetasol HC; Acid Jelly; Auralgan; Borofair Otic; Burow’s; Fem pH; Klout; Otic Domeboro; Star-Otic; Tridesilon†; VoSoL HC†; VoSoL†; Venez.: Gynovit; Kayivis; Saxacid.
Published October 08, 2018.